DECLARATION AND CERTIFICATE OF NATIONALITY

1. I do hereby certify that I am an Indian citizen and a native of India.

2. I also declare that I have never been pronounced unfit for government employment by Medical
Board or any other duly constituted Medical Authority.

Date:- Signature

DECLARATION

I,Sri/Smt S/o/d/o

of vill P.O. District

do hereby declare that I have read the Departmental volumes and regulations and order and I shall

abide by all the said rules, regulations and orders and shall also abide by such rules and orders
which

will be issued from time as I join as Postal Assistant/Gramin Dak Sevak.

Date:- Signature
 Oath of Allegiance to India and to the Constitution of India

I do swear/solemnly affirm that I will be faithful

and bear true Allegiance to India and to the Constitution of India as By Low established, that I will
uphold the sovereignty and integrity of India and that I will carry out duties of my office loyally,
honestly and with impartially.

Place:- Signature
Date:- Name
 DECLARATION
1. I Shri/Smt/Kumari declare as under:

i) That I am unmarried/a widow.

ii) That I am married and have only wife living.
iii) That I am married and my husband has no other living wife, to the best of my knowledge.
iv) That I am married and have more than one wife living.
Application for grant of exemption is enclosed.

v) That I am married to a person who has already one wife or more living.
Application for grant of exemption is enclosed

2. I solemnly affirm that the above declaration is true and I understand and that in the credit of
the declaration being to be incorrect after appointment shall be liable to be dismissed from
service.

Date:- Signature

Note: Please delete clauses not applicable.

(Application in the case of clauses 9i), (ii) & (iii) only
 APPLICATION FOR GRANT OF EXEMPTION
(vide para (iv) of the declaration)

To
The

Sir,
I request that in view of the reasons stated below. I may be granted exemption from the
operation of restriction in the recruitment to service of a person having more than one wife
living/women who is married to a person already having one wife or more.

Reasons

Date:- Yours faithfully

Signature

CHARACTER CERTIFICATE

Certified that Shri / Smt son/daughter

of

Shri/Late is personally known to me for the

last

2. To the best of my knowledge and belief Shri/Smt

 bears a good moral character and has no antecedents which render him/her unsuitable for
Government Employment.

3. Shri/Smt is not related to me.

Date:- Signature
Place:-

Character Certificate
Certified that I have known Sri/Smt son/

daughter of Sri/Late for the last

years months and that to the best of my knowledge and belief he/she bears a reputable
character and has no antecedents which render him/her unsuitable for Govt. Employment.

2. Sri/Smt is not related to

me.

Date:-

Signature
 HEALTH CERTIFICATE

I do hereby certify that I have examined Shi / Smt a

candidate for employment in the Department of Posts, India and cannot discover that he/she has any
disease communicable or otherwise, constitutional affliction, or bodily infirmity except.

I do/do not consider this qualification/disqualification for employment in the Department of

Posts, India.

His/her age is according to the own statement, years months days

and

by appearance years months

Date:- Signature

Designation of the Medical

Officer

Signature of the candidate

Left Hand Thumb and Fingers Impression

Of the candidate

Attested
By

A) Height:-
B) Figure:-
C) Complexion:-
D) Colour of Eyes:-
E) Mark of identification:- Signature
Name & Designation
Of the Medical Officer
1. I do swear that I will be faithful to India and to
the Constitution of India by the established law and that I will locally carry out the duties of my
office.
So help me God.

Date:- Signature

2. I, do hereby declare that I have read/had been explained to me the Central Civil Services,
(Conduct) Rules, 1959 and thoroughly understood them.

Date:- Signature

3. I, do hereby declare that I have read/had been explained to me Rules 103 of the Posts Manual
Vol.-II and agree to abide by its terms.

Date:- Signature

4. I, do hereby declare that I have read/had been explained to me the Government of India
(Department of Communication) Orders no ESB 124-7/40 dtd. 09.05.1951 regarding insolvency
and indebtedness and thoroughly understood them.

Date:- Signature